Valuing health technology: habilitating and prosthetic strategies in personal health systems

This paper explores the tensions in ICT-driven personal health systems innovation and the impact of these tensions on valuing health innovation for older people. We regard personal health systems (PHS) as configurational technologies and information infrastructures that need to strike a balance between offering standardized health and care packages on the one hand, and providing options for localization and personalization on the other. We use insights from Science and Technology Studies (STS) to conceptualize the configurational dynamics of PHS innovation and emphasize ‘generification work’ as an important arena for the development, assessment and adoption of personal health innovations. We explore two research and development projects of PHS service-robot platforms and build on Callon's concepts of ‘prosthesis’ and ‘habilitation’ to identify two ideal-typical generification strategies in the projects. A prosthetic generification strategy positions the robot as part of a socio-technical agencement that configures older persons into disciplined agency, while a habilitating strategy speaks to them as active actors in the innovation process. We demonstrate how the designers in both projects were often unconsciously led into a prosthetic strategy despite initial intentions to the contrary. We explain this by mechanisms of personalization, needs capturing and othering. However, elements of habilitating strategies were also present, although in a less articulated form. We identify these elements and argue that in aging societies, health innovations need to pursue prosthesis and habilitation simultaneously. We conclude our paper with implications for innovation policy and health technology assessment.